A systematic review: impact of in-office biopsy on safety and waiting times in head and neck cancer.

OBJECTIVE: This study aimed to assess the current literature on the safety and impact of in-office biopsy on cancer waiting times as well as review evidence regarding cost-efficacy and patient satisfaction. METHOD: A search of Cinahl, Cochrane Library, Embase, Medline, Prospero, PubMed and Web of Science was conducted for papers relevant to this study. Included articles were quality assessed and critically appraised. RESULTS: Of 19 741 identified studies, 22 articles were included. Lower costs were consistently reported for in-office biopsy compared with operating room biopsy. Four complications requiring intervention were documented. In-office biopsy is highly tolerated, with a procedure abandonment rate of less than 1 per cent. When compared with operating room biopsy, it is associated with significantly reduced time-to-diagnosis and time-to-treatment initiation. It is linked to improved overall three-year survival. CONCLUSION: In-office biopsy is a safe procedure that may help certain patients avoid general anaesthetic. It was shown to significantly reduce time-to-diagnosis and time-to-treatment initiation when compared with operating room biopsy. This may have important implications for oncological outcomes. In-office biopsy requires fewer resources and is likely to be cost-saving five-years following introduction. With high rates of sensitivity and specificity, in-office biopsy should be considered as the first-line procedure to achieve tissue diagnosis.

Laparoscopic instrument use in laryngeal surgery: transoral resection of a supraglottic haemangioma.

BACKGROUND: Adult laryngeal haemangiomas are rare vascular tumours that have been managed by a variety of surgical techniques. METHODS: This paper describes a case of near-fatal acute airway obstruction secondary to such a lesion, followed by our approach to surgical resection using a laparoscopic bipolar tissue-sealing device. RESULTS: This technique resulted in successful excision of the lesion, with no evidence of recurrence at one year of follow up. CONCLUSION: Laparoscopic bipolar instruments can be used for the resection of moderate to large laryngeal haemangiomas as an alternative to laser excision.

Large retropharyngeal abscess: a case of mistaken identity.

We report an unusual case of nasopharyngeal carcinoma (NPC), presenting initially as a retropharyngeal collection. We discuss the investigation, diagnosis and management of NPC and furthermore review the literature of NPC, emphasising the varied presentation. A 44-year-old Caucasian male ex-smoker presented with a 10-day history of a painless left-sided neck lump; progressive dysphagia and unintentional weight loss. Examination demonstrated a large left posterior pharyngeal swelling with soft palatal effacement, confirmed on nasoendoscopy. A CT scan revealed a fluid collection in the retropharyngeal space, which partially occluded the nasopharynx, and numerous satellite lesions were identified along with cervical lymphadenopathy. The suspected abscess was drained in theatre and nasopharyngeal biopsies were taken. These revealed Epstein-Barr virus-positive NPC. Staging investigations revealed a T4N2M0l carcinoma. Treatment consisted of radical chemoradiation therapy with curative intent. NPC is known for its varied and late presentation, and is an important condition to be aware of when considering a differential diagnosis of pharyngeal masses.

Transoral robotic resection of a large schwannoma in the retropharyngeal space.

BACKGROUND: External approaches have been traditionally used for the complete excision of large retropharyngeal space lesions. CASE REPORT: This paper describes a case of a large schwannoma of the retropharyngeal space excised transorally with the use of a robotic system. This lesion measured 2.7 × 1.2 cm in axial dimensions and over 5.8 cm in craniocaudal length. The lesion was delivered en bloc with an intact capsule. No peri- or post-operative complications were encountered. The procedure allowed quick resumption of an oral diet and a return to normal activity for the patient. CONCLUSION: This is, to our knowledge, the first report of this technique used in the excision of a large retropharyngeal space mass.

Congenital familial subglottic stenosis: a case series and review of literature.

Subglottic stenosis is a narrowing of the endolarynx and maybe classified as congenital (primary) or acquired (secondary). Congenital stenosis maybe caused by a small cricoid cartilage, thick submucosa or other laryngeal abnormalities and remains a well-known cause of stridor in infancy. It occurs sporadically and familial occurrence is rare. Our case series identifies three children with congenital subglottic stenosis born to consanguineous parents. Congenital subglottic stenosis in siblings of unrelated parents has been previously reported, but not in consanguineous parents indicating a strong genetic link. We recommend further genetic research to assess the mode of possible heritage in this disease.

Sheffield suction holder clips for endolaryngeal laser surgery.

BACKGROUND: There has been a major evolution in laryngeal surgery, largely due to an improved understanding of disease pathogenesis and advances in technology, especially the introduction of lasers. METHOD AND RESULTS: Continuous laser plume evacuation during endolaryngeal surgery improves visualisation of the surgical field. Hence, microlaryngoscopes are fitted with smoke evacuation channels on their sides. We have devised a new, simple and efficient suction holder clip for endolaryngeal surgery that has distinct advantages over other suction holders.

Treatment of paediatric laryngeal papillomas: web survey of British Association of Paediatric Otolaryngologists.

BACKGROUND AND OBJECTIVE: Recurrent respiratory papillomatosis is the most common benign neoplasm of the larynx in children. Intralesional injection of cidofovir may have some potential as an adjunctive treatment. There is no standardised protocol in the UK for the management of recurrent respiratory papillomatosis. This study aimed to investigate the management practices of surgeons treating paediatric recurrent respiratory papillomatosis in the UK. METHOD: A web questionnaire survey was sent by e-mail to all members of the British Association of Paediatric Otorhinolaryngology. RESULTS: Out of 35 respondents, 23 were at that time treating children with recurrent respiratory papillomatosis. Nineteen respondents preferred to use a microdebrider, 12 preferred laser, and 5 preferred cold steel along with either laser or a microdebrider. Twelve surgeons used cidofovir for selected patients and 12 surgeons did not use cidofovir for any patients. Cidofovir was considered after 0­4 surgical procedures by seven respondents, after 4­6 surgical procedures by four respondents and after 6 surgical procedures by six respondents. Eleven respondents warned patients about the possible side effects of cidofovir and five gave no warning. CONCLUSION: There was no consensus as to when it would be appropriate to use cidofovir, indicating the need for cidofovir usage guidelines.

General practitioners' versus consultants' perspective on indications for paediatric tonsillectomy: current trends.

AIMS: We undertook a study to ascertain what factors general practitioners consider important when referring children for tonsillectomy, and to compare these views with those of consultant ENT surgeons. METHODS: Web-based questionnaire study. RESULTS: A total of 141 general practitioners and 146 consultants responded. Tonsillectomy in children was regarded as a useful operation by 65 per cent of general practitioners and 98 per cent of consultant ENT surgeons. This difference was statistically significant (p < 0.001, chi-square test). In 1994, Donnelly et al. found that 92 per cent of general practitioners considered tonsillectomy in children a useful operation; our results were significantly different (p < 0.001, chi-square test). CONCLUSIONS: There is a good level of awareness and agreement on the currently accepted indications for paediatric tonsillectomy in both groups. However, there were important areas of difference between the two groups with regard to 'glue ear', recurrent ear infections and snoring. Standardised indications for tonsillectomy should be effectively disseminated to general practitioners.

Radio opacity of various ENT foreign bodies in sheep's neck preparation.

We conducted an experimental study to evaluate the radio densities of different ENT foreign bodies. Various ENT foreign bodies were placed in the oesophagus of a sheep's neck preparation. An X-ray lateral view of the neck was taken, following the soft tissue neck protocol. Foreign bodies were grouped depending upon their radio densities and pixel value. The visibility of different materials on plain radiographs depends on their ability to absorb X-rays, and their inherent radio density and relation between it and the tissue in which they are embedded.